Baker Tilly's The pulse of healthcare for June 9, 2015

At the agencies

On May 22, the Centers for Medicare and Medicaid Services (CMS) announced that the summer meetings of the Advisory Panel on Hospital Outpatient Payment for 2015 will be held on August 24-25. The agenda of the meeting includes (among other things) discussing the Ambulatory Payment Classification (APC) groups, more specifically, their clinical integrity and the group weights. Entities interested in offering presentations or comments may submit them via e-mail to CMS by July 24, and registration for attending the meeting will be open from June 29-July 31.    

Also on May 22, the CMS issued a final rule, which revises the agency’s oversight of national accrediting organizations (AOs). This finalizes a rule proposed in November 2011 that strengthened the agency’s oversight of AOs that apply for accreditation; the final rule is effective on July 21 of this year.

On the Hill

On May 20, the Senate Special Committee on Aging held a hearing entitled, “Challenging the Status Quo: Solutions to the Hospital Observation Stay Crisis,” during which representatives from CMS and providers expressed their concerns over the challenges presented by observation status and services. During the hearing, providers offering testimony highlighted the ways in which the so-called “two-midnight” rule places a burden on physicians regarding their classification of patients as receiving inpatient or observation services. Furthermore, Committee Chair Sen. Susan Collins voiced her concern that this rule may cause individuals to leave a hospital before they are ready due to financial concerns over staying once alerted to their status. Sen. Elizabeth Warren echoed these concerns, urging CMS to fix the problems surrounding the controversial two-midnight rule, including implementing an auditing system that is less disruptive.

On May 21, the House Energy & Commerce Committee unanimously passed the 21st Century Cures bill, which is expected to be considered on the floor in late June of this year after undergoing separate review by the House Ways and Means, Appropriations, Budget, and Rules Committees. The draft of the bill that left the Energy & Commerce Committee represents wins for providers in that hospitals were excluded from responsibility for paying for any of the bill’s provisions, and there was no tightening of the 340B eligibility rules as had been proposed. However, while 340B reforms were included in this legislation, they are expected to be a topic of continued conversation during this Congress.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.